Early days of COVID-19 were devoted to reorganizing team to save patients’ lives
By Laura Eggertson
June 19, 2023
Valérie Gagnon has drawn heavily on her adrenaline reserves.
More than two years into the COVID pandemic, the nurse co-manager and critical care coordinator at the Centre hospitalier de l’Université de Montréal (CHUM) is finally able to settle into her office again after months of working alongside her nursing team.
As clinical administrative co-manager, along with an intensive care doctor, in one of the largest intensive care units (ICUs) in Canada, Gagnon’s pre-pandemic workdays were usually spent overseeing 500 nurses and other health-care professionals. In addition to the hospital’s critical care units, she is also responsible for a nine-bed burn unit and two hemodialysis units (in-hospital and ambulatory).
Before COVID, she focused on various management projects related to continuing education, recruitement of staff, and other initiatives.
Then the pandemic took hold.
On top of her administrative responsibilities, Gagnon, a registered nurse (RN) for 25 years, worked with direct-care nurses to help them cope with some of their responsibilities and tasks.
“I put my uniform on and went into the units with the team. Mornings. Evenings. Whenever I could. Because they needed support to implement all the changes and daily directives that we received from management,” Gagnon says.
What followed were 60-plus-hour weeks, working through Christmas vacations and other holidays, and relying on a constant flood of adrenalin. Gagnon conveyed new information — which seemed to come hourly — to her teams and tackled the extraordinary medical and human resource challenges COVID presented.
“It was like a war zone,” she says. “I had to step in and make decisions.”
One of the first steps that Gagnon and her team took was closing the burn unit. She redeployed those nurses to the ICU, which contained both post-surgical patients and those with the SARS-CoV-2 virus, in two different wings of the hospital.
Patients were dying from COVID-19, and the hospital had to open more beds. More and more people were getting sick.
During the first months of the pandemic, those deaths included a mother and daughter who arrived at the hospital separately, unknown to Gagnon’s nursing team.
When a nurse phoned the daughter’s emergency contact to report the young woman’s death, only then did the hospital learn, when her father answered his wife’s cellphone, that their patient’s mother was also at the hospital in another unit with COVID.
The mother died a few days after her daughter.
“That was the moment I remember the most — the mother and daughter,” Gagnon says. “That night, it was very difficult for the team.”
Intubating seriously ill patients to place them on ventilators was standard practice during those first frantic months. But many people never came off the ventilators.
Gagnon and her team, who were feverishly scanning news reports and medical journals, wanted a better solution — a medical intervention that would keep patients alive.
As a result of research they conducted, they learned that some hospitals were reducing deaths by placing COVID patients in a prone position on their stomachs. This practice, which increases the volume and circulation of oxygen and carbon dioxide in the lungs, often avoided intubation and ventilation.
Created COVID response team
A COVID emergency response team was quickly set up. The team — which included the co-manager of intensive care, a team that specialized in training nurses, and others — ensured everyone on the team was safe and every patient who needed a bed got one. Simulations were also set up so that the entire multidisciplinary team could practise safe interventions.
Around that time, the hospital considered reopening the major burns unit, since patient deaths were decreasing and the nursing shortage was a little more under control.
Previously, hospital management had eliminated access to the major burns unit due to the need to redeploy nurses to other care areas.
In addition, in only one year since the onset of the pandemic, the successful recruitment and retention of nursing staff despite the health crisis made it possible to reopen more than 50 critical care beds that had previously been closed.
Those same management skills prepared Gagnon to keep her team focused and motivated even during the most difficult days of the pandemic.
“She is known to always think outside the box and to constantly challenge the status quo of any situation in order to proactively improve the quality of care that her team provides and to purposefully create an environment where the skills of her staff are blooming,” says Renée Descôteaux, CHUM’s director of nursing.
A major skills-building and competency program and a scheduling system that gives nurses two out of every three weekends off and six-day-on, eight-day-off blocks of time is one of the secrets to Gagnon’s success, she says.
“This strategy gives people more family time,” she says. “We keep nurses because they have better working conditions. Nurses at other hospitals have to do some mandatory overtime. But here we have a choice. We are lucky, and we are able to fill all our positions.”
Hired nursing assistants
But this time, during the pandemic, Gagnon needed a different approach.
She researched the roles of nursing assistants and convinced her superiors to allow her to hire 12 of them. In five weeks, with the help of the chief physician of the ICU and a multidisciplinary team, the new team trained the nursing assistants to care for burn victims.
Because of the new positions, she also worked with the existing expert nurses to persuade them to delegate care and trust the assistants.
“Even if we thought that this was not a solution, Valérie proved us wrong,” says Descôteaux.
“She was able to introduce nursing assistants and to improve the quality of care, which allowed nurses to be used to their full scope of practice.”
The hospital reopened its beds in the burns unit, where nurses and nursing assistants work together to care for patients. They helped ease the pressure on remaining critical care nurses and shared follow-up care plans.
“It worked very, very well,” Gagnon says. “I’m really proud of their commitment.”
She’s now supporting any of those nursing assistants who want to return to school to become RNs by working around their academic schedules.
For Gagnon, who started her career working in a hospital kitchen and laundry and is the first in her immediate family to attend university, her ability to innovate and lead brings her great satisfaction. She keeps going despite the exhaustion that lingers from the pandemic.
To recharge, Gagnon hangs out at her “cabin in the woods” with her husband, Steve, and her grown sons, Alex and Zacharie. “It’s a place my family goes to recharge our batteries. We see friends, share great food, and enjoy quality time. We like to hike, bike, and read,” she says.
But Gagnon was not content to rest between waves of COVID. In the summer of 2022, she helped develop a mentorship project that places ICU nurses in general units to support colleagues with less than two years of practice experience.
“To date, 500 mentorship activities have taken place, to the incredible satisfaction of both groups,” Descôteaux says. “This project allows ICU nurses to get closer to general units and promotes knowledge transfer and collaboration between the two groups.”
Gagnon’s accomplishments come, in part, from her need to keep proving herself.
“I don’t come from a rich family, and I have to work hard to have what I have now. I don’t take things for granted,” she says.
Nurses in general have to prove their value to the health-care system, she believes.
“I believe in the profession of nursing, and I want to share with other nurses that if you believe in it, you can do it,” she says.
“I believe we have to offer the same quality of care that we would expect ourselves.”
Laura Eggertson is a freelance journalist based in Wolfville, N.S.